Friday, April 26, 2013

Peter Spier's wordless book "RAIN" captures the beauty and wonder of abrother and sister's joyous experiences in the rain. From the first small drops of rain to the clear blue sky of a bright new morning.

ClickHERE to go to the blog," What Do We Do All Day?" where the blogger shares suggestions and examples of three ways to “read” wordless books.

Wednesday, April 24, 2013

The Ling-6 sounds represent various different speech sounds from low to high
pitch (frequency). They help to test your child’s hearing and check that they have
access to the full range of speech sounds necessary for learning spoken language.

Click HERE to access this from Cheryl L. Dickson and Cochlear Ltd 2010

Thursday, April 18, 2013

Early Expectations for a Child with a Cochlear Implant

Families often have many emotions about their child’s cochlear implant (CI). One common feeling is of uncertainty. Parents are unsure of what changes they will see and when their child might talk. Surgery and being fitted with external equipment begins the process. The first use of the activated implant is awareness of sounds. Family members can be very involved in helping a child develop a range of listening skills. As a child increases his listening and understanding, his speech skills can expand.

Mapping

The sounds transmitted through a CI are not the same as those heard with a hearing aid. A child’s brain needs practice recognizing these new sensations as sound. How quickly a child uses his CI depends on many factors including when he was deafened, when the loss was diagnosed, the time between diagnosis and implantation, the amount of hearing provided by hearing aids and the cause of the hearing loss. All these factors and more impact a child’s recognition and understanding of new sounds.

After implant surgery there are several follow-up appointments to program or MAP it. When the CI is first activated a child might become very quiet or his vocalizations may increase. He may not yet be attentive to other voices or sounds. These varied beginning responses are a natural part of the listening process but parents often worry that the implant is not working. Learning to listen takes time and the family can feel assured that few or no responses can be typical at the start.

After the initial mapping is complete, most children visit their audiologist every 3-4 months. The audiologist can suggest expectations for the child’s responses. Families, teachers and therapists can help document their observations of how the child is meeting those expectations. Parents can also request additional appointments at any time if their child’s responses change unexpectedly.

Listening

A child with a CI discovers and uses sound through the same developmental steps as a child with typical hearing. During the first three months after the implant is activated, parents may notice spontaneous reactions when certain sounds are heard. A child might look up or startle slightly. Then the child may begin to search for the sound as he looks in the direction of what he hears.

A child learns to listen from parents talking, singing and pointing out sounds. Parents might use “bye, bye” “uh oh” and other sing-song words in addition to typical speech. Sounds from the microwave, musical toys, water running or an airplane overhead are examples of natural events that can be part of early listening. A family’s enthusiasm and interest in sounds can encourage a child to be aware and become excited about many sounds around him.

The developmental stages for listening are detection, discrimination, identification and comprehension.

Detection

The first level of listening is an increasing awareness of sound. A child might now show interest or reactions to an increasing amount of sounds. Parents can call attention to different sounds and search with their child for sound sources to encourage increased "detection".

Discrimination

The next level of auditory development is noticing differences between sounds. A child now might repeat "mmmm" after someone says "yummmm". He does not yet understand the meaning of sound but he is able to "discriminate" between sounds.

Identification

Identification involves making associations with sounds. A child now might look toward the door when knocking occurs. He may not yet know that the sound indicates Grandpa is at the door but he is able to “identify” the source of the sound.

Comprehension

Understanding what is heard is a more complex skill developed after detection, discrimination and identification. A child now shows he knows the meaning of some sounds or words. If he gets the shoes when asked to do so and tries to put them on, he “comprehended” what was said!

As a child advances through these stages, families can create multiple listening opportunities throughout the day. Parents can use many ways to help a child become a better listener. Suggestions appropriate for babies and preschoolers include:

Play together and talk in play. Use words, make sounds for motions and invent noises for toys.

Enjoy songs, rhymes and acting out familiar verses. Encourage him to participate with you.

Read books. Use voice inflection and demonstrate many levels of speech and types of sounds.

Talk about what he is doing. When he is watching you, describe what you are doing too.

Listen and move to music. Explore turning on and off toys and objects that make sounds.

Point out sounds occurring both indoors and outdoors and especially for things he enjoys.

Pause first to give your child time to think about and then react to sounds and speech.

Talking

Early expectations for a child with an implant include increased attention, listening and communication. A child’s hearing or CI age can be measured in weeks and months. With much daily experience, special services and ongoing support, the goal is for a child’s listening skills to eventually match his chronological age. Together with their speech and hearing team, parents can guide their child through systematic and successful experiences first in listening and then in speech. Learning to be a listener is complex skill and the first fun step using a CI! Then comes talking!

Keep on Talking: Pre & Post Ci Process

Reprinted from the Chatterbox Blog

You have made the decision to provide your child with a cochlear implant. You might be wondering about what you can do before the surgery, while you wait for activation and after the first mapping. Here are simple suggestions your family can consider. Your child’s speech therapist and cochlear implant team will also have suggestions about the many ways you can provide audition and language.

What can I do before my child receives the implant?You want your little one to benefit from his implant from the moment of activation. And that means he must be prepared. Even when you are unsure of what he hears with hearing aids, there is still much you can do.

Talk near the microphone of his hearing aids when you are looking at a book together, playing on the floor with his favorite toys, cuddling or enjoying any family activity. Just take a minute to lean close to your child’s hearing aid when you talk.

Sing, sing, sing! Sing about picking up toys. Sing about going to bed. Sing children’s songs. Hold your child in your arms, sway to the rhythm of your song and be close to his hearing aids. You may be unsure of what he hears, but he might perceive some bit of rhythm. This will be very important in the development of spoken language skills.

Vocal play! Use your voice in a playful manner. Say, “Up, up, up, dooooowwwn” as you lift your child and place him into a chair or “Hellooooo,” as you enter the house.

Provide lots of play, reading and daily experiences to help your child learn. Language is a part of all that you do and your child will gain new words, ideas and knowledge as you fill his day with many conversations and activities. He can learn much from the enjoyable stimulation his family provides during this time.

What should I do between surgery and the time of activation?

During the time that your child has a bandage, he might not be able to wear his hearing aid on the non-implanted ear. And if he has received simultaneous bilateral implants, he will not be able to hear you before the implant is activated. But you can still communicate. Since social interaction is basic to communication, you can encourage eye contact and smiles as well as pointing and gestures. If you know sign language, use it now!

Get down to your child’s level and provide language, “You want water? OK, Mommy will get some water for you.” If he can’t hear your voice, get up and go to him. Show him a sandwich and ask if he is ready for lunch. Visual clues are important now, so give your little one every opportunity to connect what he sees with what you are saying. And, expect “turn taking” in your conversations.

If your child is receiving one implant, he can wear his hearing aid on the non-implanted ear while waiting for the initial stimulation. However with only one hearing aid, your little one will not be able to localize the direction of a sound because all sounds will be heard from the side with the hearing aid. He will not hear as well in noise, such as in the car or if the TV is on. And in general, his under•standing of sound could be diminished. When you can, speak close to the microphone of the hearing aid, and use some visual techniques, too.

What can I expect at the time of activation?

Your cochlear implant team will explain the initial activation process. Some children do not react, while others smile or become fearful. Naturally you do not want your little one to be afraid of the sounds he hears, but his response does indicate that he is hearing and that is important.

If your child receives a second implant a few months after the first, you can expect him to be more comfortable with the mapping session, however it will take time for him to become accustomed to hearing with the new implant.

What can I expect after activation?

You have to repeat what was done when your child first received his hearing aids. If your little one has experienced vocal play and if there was an auditory connection to sound, he will connect to the sounds he hears with the implant. This is why the pre-implant time is so important.

Go back to vocal play and singing. Have fun with various sounds. The cow says, “Mooooo.” The kitty says “Meow!” Fly toy airplanes while you say, “wheeeee.” Think of some simple children’s songs and sing them every day.

Help your child recognize and understand environmental sounds such as the telephone, microwave, keys, cars and trains. Ask a friend to knock on the door or ring the door bell. Take your child to the door as you say, “Listen. That’s the doorbell. Let’s see who is at the door.” Listen to the washing machine together and then look at the clothes inside. Help your child understand that sounds have meaning.

Draw his attention to voices, too. “Grandpa is calling you. Listen.” He should begin to respond to voices quickly, so talk, talk, talk! And help him learn his name, too. Use your little one’s name when you talk to him. “Who are you? You are Raúl. Raúl.” Point to him as you talk. “Who am I? I’m Mommy.” Point to yourself.

Initially your child may show a lot of response to voices and environmental sounds. Then a plateau may occur while his brain is developing the ability to use the implant. Learning to listen and under•stand takes time and practice. Be patient and keep talking.

If you have typical hearing, you probably tend to overlook many sounds in your everyday living
environment. You probably don’t think about the click of a light switch, whir of the ceiling fan, or the
bang of something being dropped. Children with hearing loss need to learn about these many
sounds that are part of the everyday world. This list of common sounds will give you ideas about what
to point out to your child as you help him develop his listening skills.